<!-- BEGIN INSTRUCTIONS -->
{INSTRUCTIONS}<br /><br />
<!-- END INSTRUCTIONS -->

<table border="0" width="80%" cellpadding="10" cellspacing="0">
<tr><td>
{NAME_LABEL}<br />
{NAME_INPUT}<br /><br />
{BLURB_LABEL}<br />
{BLURB_INPUT}
</td><td align="left">
{OPTIONS_LABEL}<br />
{OPTIONS_INPUT}<br /><br />

<!-- BEGIN OPTION_SET -->
{OPTION_SET_LABEL}<br />
{OPTION_SET_INPUT}<br /><br />
<!-- END OPTION_SET -->

{REQUIRE_LABEL}<br />
{REQUIRE_INPUT}
</td></tr>
<tr><td colspan="2" align="left">
{BACK_BUTTON}&#160;{NEXT_BUTTON}
</td></tr>
</table>
